Diabetes growing burden on health system, says advocacy group

Michael Cloutier, president of the Canadian Diabetes Association at his Toronto office Dec.16, 2010 in front of a portrait of Dr. Charles Best, co-discoverer of insulin and the founder of the Canadian Diabetes AssociationPhoto by
Hugh Wesley

The growing prevalence of diabetes among Canadians threatens to not only become a health crisis for this country, but also an economic one, says a leading organization in the fight against the disease.

The Canadian Diabetes Association says diabetes cost the Canadian health system $12.2 billion in 2000 and predicts that figure will rise to $16.9 billion by 2020.

"The situation in Canada is significant and very serious on the basis of the current prevalence and cost, and also the alarming increase that's going to occur in the next 10 years if we don't take action immediately," says Michael Cloutier, president of the Canadian Diabetes Association.

"It's not only a huge social-health issue, but it's a significant economic issue and one that will be debilitating if we are not able to get on top of it. . . . It is going to create a tremendous burden on government and society as a whole from a cost perspective in being able deliver on many other important mandates."

Cloutier is calling for more funding and co-operation from a variety of players — government, corporations and individuals — to help stem the tide of diabetes and its repercussions.

The Diabetes Association's financial records show it downscaled operations somewhat last year as fundraising slowed down. Its overall funding for research fell to $6.8 million from $7.5 million, and its services spending declined to $19.1 million from $21.1 million.

Fundraising was down about $3 million for the Diabetes Association's 2009-10 fiscal year to $25.5 million.

Cloutier says putting more effort — and money — into fighting diabetes now will save bundles down the road.

"We believe that an investment in diabetes is an excellent investment and will pay huge dividends in terms of a return both in the short term and in the long term," Cloutier says.

Statistics Canada recently listed diabetes as the sixth-leading cause of death in the country, killing 7,394 people in 2007.

But that's not the whole story. The Diabetes Association says it is a "contributing factor" in about 41,500 deaths each year. Diabetes leads to many other ailments, including heart disease and stroke, which are second and third, respectively, after cancer in terms of Canada's leading causes of death.

The Diabetes Association's's data show that 80 per cent of people with diabetes will die of a heart attack or stroke. It also says that more than 40 per cent of new kidney-dialysis patients in 2004 had diabetes and that it is the leading cause of blindness in Canada.

Cloutier says that 80 per cent of the health-care costs associated with diabetes are for "downstream complications."

"That would be heart attack, stroke, kidney failure, blindness, amputations, just to name a few critical elements," he says.

The Diabetes Association says that by 2020, about 10 per cent of Canada's population, or 3.7 million people, will have diabetes. It estimates that three million people in Canada are currently living with diabetes and another six million are in a state of prediabetes. The latter applies to people with higher-than-normal blood-sugar levels, but not enough to be classified as diabetes. However, about 50 per cent of these cases are expected to turn into full-fledged diabetes.

The federal government projects that 2.6 million Canadians will have been diagnosed with diabetes by next year and "many more are unaware they have the disease," according to a statement from Public Health Agency of Canada. It says the number of known cases of diabetes is growing by about seven per cent each year.

Why are so many people getting diabetes? Cloutier says much of it is because of Canada's aging population. With life expectancies on the rise, the odds of getting any number of diseases, including diabetes, increases.

Lifestyle is also part of it. Inactivity and bad eating habits, which lead to being overweight, are seen as being common precursors to diabetes. Smoking among people with diabetes has been found to significantly increase the risk of heart disease.

As well, it has been found that aboriginals, and people of Asian and African decent — accounting for most of Canada's immigrants — have higher rates of diabetes than the general population.

"There is an ongoing debate around a genetic predisposition that some people feel occurs or doesn't occur," says Cloutier. "But what is most certainly occurring in those populations is the impact of the North American lifestyle."

One part the effort called for is increasing awareness as to how personal choices are related to diabetes.

Also, Cloutier feels more resources should go toward trying to find a cure for diabetes, and toward medicine, technology and professionals that can help people already diagnosed with diabetes manage and prevent the onset of the most serious complications.

The federal government puts $18 million a year toward a diabetes strategy that focuses on prevention, early detection and treatment. Also, it gave $36.5 million last year to the Canadian Institutes of Health Research to study the disease. As well, there is a two-year, $110-million program underway that specifically targets aboriginal communities with prevention efforts, health-awareness campaigns and other diabetes-related services.

Diana MacKay, director of health programs at the Conference Board of Canada, is part of an effort to get employers aware of the economic costs of diabetes and other chronic diseases.

Beyond the Diabetes Association's's health-cost projections — which MacKay says might actually underestimate things— she says there's an economic impact to be had in lost worker productivity. This comes from the need of people with conditions like diabetes to be given time for things such as taking medication, going to medical appointments and being properly nourished.

MacKay is certainly not recommending employers shun workers with such conditions or deny them opportunities, while on the job, to take care of themselves.

"There's this thing called motivation, and my view is that motivation significantly factors into productivity," she says. "I think people will be more productive if they're happier at work."

MacKay says chronic illnesses carry a "stigma" in Canadian workplaces because of the way they can affect a worker's productivity. But, given the scarcity of labour that will increase in the years ahead as members of the baby-boomer generation retire, she says employers cannot afford to deny any group of people proper job consideration. And to keep them there, and keep them productive, employers have to make these people feel comfortable.

As well, MacKay says employers can play a role in preventing diabetes and its more serious complications. Gym memberships, on-site fitness programs, help in quitting smoking and ensuring access to healthy food are just a few of the examples she cites.

"Prevention is not expensive if it's done well, and we don't expect the government to do all of the solving of the problem," she says. "Employers need to be part of the solution here."

Paul Grootendorst, a health economics professor at the University of Toronto, agrees that diabetes is "one of the bigger ones" when it comes to illnesses that will have the most strain on the health system as the population ages.

"It's expensive to manage because a lot of practitioners are involved and you have to get pharmacists involved," he says.

Better integration between different branches of professionals that help a patient deal with diabetes — ranging from various doctors to pharmacists — could help save health-care dollars, Grootendorst says.

He agrees that getting people to change their lifestyles would be one of the most effective ways to prevent diabetes, but on that, he adds "good luck doing that."

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